Providers Need a More Focused Denials Management Strategy

By Jasmyne Ray for HeathLeaders

A new survey finds that three of every four RCM executives are struggling to address a surge in denials. Revenue cycle leaders are seeing an increase in denials and claim errors.

Key Takeaways:

• RCM solutions can help make a dent in the denials, but frequent policy changes and coding updates can set them back
• Leaders are having to focus their denials management efforts by leaning into RCM solutions, tracking the reasons for denials, and getting system leaders involved.

Denials management is a consistent issue within revenue cycle operations but seems to have worsened in recent years.

In a recent survey of 200 RCM executives conducted by Experian, more than 75% said denials are increasing. That’s a sharp increase from a 2022 survey, where 42% of executives acknowledged an increase in denials.

According to the survey, 55 percent of RCM leaders have seen an increase in claim errors, and 75% say payers are making more frequent changes to their policies.

Sporadic policy updates, along with fixing incorrect CPT codes, take time to address. And that’s putting pressure on RCM teams.

Carle Health has seen a 22% increase in denials year-over-year but has seen some success in addressing the issue with front-end solutions and staff stepping up claim management efforts.

The system’s prior authorization solution has saves specialists 10 minutes per request and where last year it took the system 46 days to appeal a denied prior authorization request, it currently takes them 36.5 days.

When it comes to appeals, the system’s revenue cycle partners are taking a more focused approach, leaning on data analytics to track trends and additional assistance from system executives.

Revenue cycle staff and leaders meet monthly to monitor progress and denial trends, updating system leadership on their findings so that they and the operations teams can assist in resolving them. In tracking denial trends, staff found that policy changes and issues with interoperative CPT codes were the reason for many of them.

However, while payers seem open to addressing the health system’s concerns, according to Aron Klein, vice president of finance operations and supply chain, resolving them takes longer than they would like.

“Payers rely on technology solutions just like we do to manage processes on their side,” Klein previously told HealthLeaders. “Which ultimately, if something [happens] on their side, it takes time to resolve, which ultimately delays processing or receipt of payment on our side.”

Jasmyne Ray is the revenue cycle editor at HealthLeaders.